Daily Endocrinology Research Analysis
Analyzed 168 papers and selected 3 impactful papers.
Summary
A cluster randomized controlled trial showed that an mHealth-assisted, school-based lifestyle program reduced BMI and improved hepatic fat and stiffness in children with overweight/obesity. A prospective ICU study demonstrated that continuous kidney replacement therapy clears TSH and fT4, contributing to persistent non-thyroidal illness syndrome. In type 1 diabetes, high and prolonged glucose excursions explain discordance between GMI and HbA1c, refining CGM-based risk interpretation.
Research Themes
- Digital health and pediatric obesity
- Endocrine alterations during kidney replacement therapy
- CGM analytics and biomarker discordance in type 1 diabetes
Selected Articles
1. Effect of an mHealth-assisted multifaceted lifestyle intervention on body-mass index, hepatic fat content and stiffness in children with overweight or obesity: a cluster randomised controlled trial.
In a cluster randomized trial across six primary schools (n=331, ages 8–10), an mHealth-assisted, multi-component lifestyle program significantly reduced BMI and improved hepatic fat content (CAP) and liver stiffness (LSM) versus controls. Analyses accounted for cluster design and baseline covariates, and post-hoc modeling suggested favorable macroeconomic benefits.
Impact: Provides high-quality RCT evidence that scalable, digitally assisted lifestyle programs can improve both adiposity and liver health in children, addressing two major endocrine-metabolic risks.
Clinical Implications: Supports integrating mHealth-enhanced, school-based lifestyle interventions into pediatric obesity care pathways, with CAP/LSM as meaningful adjunct outcomes beyond BMI.
Key Findings
- Cluster RCT (6 schools, n=331) showed significant BMI reduction in the intervention versus control group.
- Hepatic fat content (CAP) and liver stiffness (LSM) improved with the mHealth-assisted program.
- Intention-to-treat analyses with mixed models accounted for clustering and baseline covariates; trial registered (NCT05482191).
Methodological Strengths
- Cluster randomized controlled design with intention-to-treat analysis
- Objective hepatic endpoints (CAP, LSM) alongside BMI; preregistered trial
Limitations
- Single-city setting may limit generalizability
- Follow-up duration for durability of effects not detailed in abstract
Future Directions: Multisite, longer-term pragmatic trials to assess durability, scalability, and cost-effectiveness; integration with family and community components; exploration of phenotypic responders.
BACKGROUND: Lifestyle modification represents the cornerstone of the prevention and early management of obesity, hepatic fat content and stiffness in children. We aimed to evaluate the effectiveness of an mHealth-supported multifaceted lifestyle intervention on body-mass index (BMI), hepatic fat content and stiffness in children with overweight or obesity, and to estimate its potential long-term macroeconomic benefits. METHODS: In this cluster randomised controlled trial, six primary schools in Ningbo, China, were randomly assigned (1:1) to an intervention or control group. Children aged 8-10 years with overweight or obesity were enrolled. The intervention integrated school-based health education and polices, physical activity promotion, dietary guidance delivered by clinical nutritionists, and supportive mHealth components. Primary outcomes were changes in BMI, controlled attenuation parameter (CAP), and liver stiffness measurement (LSM). Intention-to-treat analysis was performed using generalised linear mixed models accounting for school-level clustering and adjusting for baseline outcome values, age, and sex. A post-hoc macroeconomic simulation projected long-term economic effects. This trial is registered with ClinicalTrials.gov, NCT05482191. FINDINGS: From 6 to 30 September, 2022, 331 children (mean age 8.5 years [SD
2. Thyroid Function with Continuous KRT: A Prospective Study.
In a prospective ICU cohort (50 CKRT vs 50 controls), CKRT patients exhibited persistently low fT4 and fT3 with detection of TSH and fT4 in dialysate, indicating removal by CKRT. Severe, persistent non-thyroidal illness syndrome occurred in most CKRT patients, and none achieved euthyroid status while on therapy.
Impact: First demonstration that CKRT clears TSH and fT4 with sustained NTIS, redefining endocrine management in critically ill patients on CKRT.
Clinical Implications: Clinicians should anticipate and monitor persistent NTIS during CKRT; routine thyroid hormone testing and cautious interpretation are warranted, and trials of hormone supplementation may be considered in selected cases.
Key Findings
- CKRT patients had significantly lower fT4 and fT3 than ICU controls throughout the observation window.
- TSH and fT4 were detected in CKRT effluent, demonstrating extracorporeal clearance.
- Severe, persistent NTIS was common; no patient attained euthyroid status during CKRT.
Methodological Strengths
- Prospective design with concurrent ICU control group
- Serial serum and effluent measurements with mixed-effects modeling and FDR correction
Limitations
- Single-center observational study limits generalizability
- No interventional testing of thyroid hormone replacement
Future Directions: Randomized trials to test thyroid hormone strategies during CKRT; pharmacokinetic modeling to optimize dosing under extracorporeal clearance.
BACKGROUND: AKI and ESKD requiring continuous kidney replacement therapy (CKRT) are associated with a high mortality rate. Solutes up to 40 kilodaltons (kDa) in size are amenable to CKRT clearance which includes thyroid stimulating hormone (TSH) (28 kDa), free thyroxine (fT4) (0.78 kDa), and free triiodothyronine (fT3) (0.68 kDa). The effect of CKRT on TSH and thyroid hormone clearance, thyroid function, and the hypothalamic-pituitary-thyroid (HPT) axis is unknown. METHODS: This prospective, single-center observational study enrolled 50 ICU patients requiring CKRT and 50 control ICU patients. Serum TSH, fT4, fT3, and reverse T3 (rT3) were measured prior to and on days 1, 3, 8, and 14 after CKRT initiation and at the same time points relative to enrollment in control patients; effluent TSH, fT4, and fT3 were measured on days 1, 3, 8, and 14. Thyroid function status was adjudicated on days 1, 3, 8, and 14. Statistical analyses included employment of linear mixed modelling and time-dependent adjustments, and ANOVA with FDR correction. RESULTS: Prior to and during CKRT, CKRT patients had lower fT4 and fT3 levels compared to controls, with a higher proportion of values below the normal reference range. TSH and fT4 were detected in the CKRT effluent, indicating clearance by CKRT. Severe and persistent non-thyroidal illness syndrome (NTIS) was seen in the CKRT cohort. No patient achieved euthyroid status while receiving CKRT. CONCLUSIONS: This is the first study to assess thyroid function and clearance of TSH and thyroid hormones during CKRT. We demonstrate that severe NTIS - characterized by low levels of fT4 and fT3 - occurs in the majority of CKRT patients. Furthermore, NTIS is persistent in patients receiving CKRT, which may be influenced by CKRT-mediated TSH and fT4 clearance. These novel complications may contribute to the high mortality rate observed in patients with either AKI or ESKD who receive CKRT.
3. High-Amplitude and Prolonged Glucose Excursions as a Key Determinant of Discordance Between Glucose Management Indicator and Glycated Hemoglobin in Type 1 Diabetes.
Analyzing 611 adults with type 1 diabetes, frequent high (≥250 mg/dL) and prolonged (≥90 min to peak) excursions were strongly associated with higher GMI-to-HbA1c and uGMI-to-HbA1c ratios across devices and models. Incorporating GRID-derived excursion metrics improved the informativeness of GMI/uGMI for albuminuria and TyG index versus HbA1c alone.
Impact: Refines interpretation of CGM-derived metrics by identifying excursion phenotypes that drive GMI–HbA1c discordance, with implications for risk stratification and therapeutic targets.
Clinical Implications: When GMI and HbA1c disagree, clinicians should assess high/prolonged excursions; targeting these patterns may align GMI with risk and guide treatment beyond mean glucose.
Key Findings
- Excursions with peak ≥250 mg/dL and time-to-peak ≥90 min independently associated with higher uGMI/HbA1c ratios across CGM devices.
- GRID-derived metrics reshaped associations of GMI/uGMI (but not HbA1c) with albuminuria and TyG index.
- Findings held after adjustment for age, sex, eGFR, and HbA1c group, and across alternative GMI formulations.
Methodological Strengths
- Large sample with standardized 90-day CGM and paired HbA1c within ±15 days
- Device-agnostic analyses and robust modeling including spline functions and covariate adjustments
Limitations
- Observational design limits causal inference
- Generalizability may be affected by device types and clinical setting
Future Directions: Interventional trials targeting high/prolonged excursions to test alignment of GMI with outcomes; integration of GRID metrics into clinical dashboards.
OBJECTIVE: Discordance between the glucose management indicator (GMI) and hemoglobin A1c (HbA1c) is frequently observed in diabetes, yet its physiological basis remains unclear. This study investigated how specific glucose excursion patterns captured by continuous glucose monitoring (CGM) contribute to this discordance in individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS: Ninety-day CGM traces from 611 adults with type 1 diabetes were paired with HbA1c results obtained within ±15 days. Glucose excursions were quantified using the glucose rate increase detector (GRID) algorithm with varied peak glucose and time-to-peak thresholds. Discordance was defined using GMI-to-HbA1c and updated GMI (uGMI)-to-HbA1c ratios, and associations with GRID-derived excursion metrics were evaluated alongside conventional CGM-derived variability metrics. RESULTS: Excursions with peak glucose ≥250 mg/dL and time to peak ≥90 min were significantly associated with higher uGMI-to-HbA1c ratios after adjustment for age, sex, eGFR, and HbA1c group, with consistent findings across CGM devices (sensor type 1: β = 0.174, 95% CI 0.147-0.201; sensor type 2: β = 0.102, 95% CI 0.068-0.136; both P < 0.001) and alternative GMI formulations. In restricted cubic spline analyses, adjustment for GRID-derived excursion metrics differentially reshaped the associations of HbA1c, GMI, and uGMI with albuminuria and elevated triglyceride-glucose (TyG) index in an outcome- and context-dependent manner, preferentially enhancing the informativeness of GMI and uGMI-but not HbA1c. CONCLUSIONS: Frequent high and prolonged glucose excursions were consistently associated with GMI-HbA1c discordance across devices, HbA1c strata, and analytic conditions. GRID-derived excursion metrics modify the relationship between GMI/uGMI and glycemia-associated risk.